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Eshak TB, Hobkirk AL, Whitener CJ, Conyers LM, Hwang W, Sznajder KK. Syndemic of Substance Abuse, Depression, and Type 2 Diabetes and Their Association with Retention in Care Among People Living with HIV. AIDS Behav 2024; 28:1612-1620. [PMID: 38281250 DOI: 10.1007/s10461-024-04275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
Substance abuse (SA), depression, and type 2 diabetes (DM2) often co-occur among people living with HIV (PLHIV). Guided by a syndemic framework, this cross-sectional retrospective study examined the cumulative and interaction effects of SA, depression, and DM2 on retention in HIV care (RIC) among 621 PLHIV receiving medical care in central Pennsylvania. We performed logistic regression analysis to test the associations between SA, depression, and DM2 and RIC. To test the "syndemic" model, we assessed additive and multiplicative interactions. In an unadjusted model, a dose-response pattern between the syndemic index (total number of health conditions) and RIC was detected (OR for 1 syndemic factor vs. none: 1.01, 95% CI: 0.69-1.47; 2 syndemic factors: 1.59, 0.89-2.84; 3 syndemic factors: 1.62, 0.44-5.94), but no group reached statistical significance. Interactions on both additive and multiplicative scales were not significant, demonstrating no syndemic effect of SA, depression, and DM2 on RIC among our study sample. Our findings highlight that comorbid conditions may, in some populations, facilitate RIC rather than act as barriers, which may be due to higher levels of engagement with medical care.
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Affiliation(s)
- Tarek B Eshak
- Department of Public Health, College of Health Professions, Slippery Rock University, Slippery Rock, PA, USA.
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State University, Hershey, PA, USA
| | - Cynthia J Whitener
- Department of Medicine, Penn State University, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Liza M Conyers
- Department of Educational Psychology, Counseling, and Special Education, Penn State University, University Park, PA, USA
| | - Wenke Hwang
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
| | - Kristin K Sznajder
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
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Kurniawan AL, Schretzmann J, Paramastri R, Cho A, Sié A, Fischer MS, Bärnighausen T, Ditzen B. Relationship satisfaction and metabolic health parameters: a cross-sectional study in Burkinabe population of older adults. BMC Public Health 2024; 24:827. [PMID: 38491462 PMCID: PMC10943782 DOI: 10.1186/s12889-024-17998-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/05/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Over- and undernutrition coexist in many African countries and pose a threat to metabolic health. This study assessed the associations between relationship satisfaction and Body Mass Index (BMI), waist circumference (WC), and glycated hemoglobin (HbA1c), in a rural population of older adults in Burkina Faso. It also explored potential gender differences and the mediating role of depressive symptoms. METHODS Data from the "Centre de Recherche en Santé de Nouna (CRSN) Heidelberg Aging Study (CHAS)," a cross-sectional population-based study conducted in 2018 in Burkina Faso, were used in our study. Hierarchical linear regression models were applied for each of the three outcome variables. Among 2291 participants aged 40 years or older who provided data on relationship satisfaction, 2221, 2223, and 2145 participants had BMI, waist circumference (WC), and HbA1c values respectively. RESULTS Higher relationship satisfaction (CSI-4 score) was associated with increased BMI (β = 0.05, p = 0.031) and WC (β = 0.12, p = 0.039). However, the association of CSI-4 and BMI became non-significant after controlling for depressive symptoms (PHQ-9 score) and physical inactivity (BMI: β = 0.04, p = 0.073). Depressive symptoms fully mediated the relationship between relationship satisfaction and BMI (β = -0.07, p = 0.005). There was no significant association between relationship satisfaction and HbA1c. These results were consistent across genders and age groups. CONCLUSION Higher relationship satisfaction may lead to increased body weight among Burkinabe adults aged 40 years and older, and depressive symptoms may be a mediator in this association.
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Affiliation(s)
- Adi Lukas Kurniawan
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
| | - Julius Schretzmann
- Institute of Medical Psychology, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Rathi Paramastri
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Alyssa Cho
- Epidemiology, Public Health, and Impact, International Vaccine Institute, Seoul, South Korea
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Melanie S Fischer
- Institute of Medical Psychology, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Psychology, University of Marburg, Marburg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
- Africa Health Research Institute (AHRI), KwaZulu-Natal, Somkhele, South Africa.
| | - Beate Ditzen
- Institute of Medical Psychology, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany.
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Quach LT, Ritchie CS, Reynolds Z, Paul R, Seeley J, Tong Y, Hoeppner S, Okello S, Nakasujja N, Olivieri-Mui B, Saylor D, Greene M, Asiimwe S, Tindimwebwa E, Atwiine F, Sentongo R, Siedner MJ, Tsai AC. HIV, Social Networks, and Loneliness among Older Adults in Uganda. AIDS Behav 2024; 28:695-704. [PMID: 38281251 PMCID: PMC10947585 DOI: 10.1007/s10461-023-04258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024]
Abstract
Loneliness among older adults has been identified as a major public health problem. Yet little is known about loneliness, or the potential role of social networks in explaining loneliness, among older people with HIV (PWH) in sub-Saharan Africa, where 70% of PWH reside. To explore this issue, we analyzed data from 599 participants enrolled in the Quality of Life and Ageing with HIV in Rural Uganda study, including older adults with HIV in ambulatory care and a comparator group of people without HIV of similar age and gender. The 3-item UCLA Loneliness Scale was used to measure loneliness, and HIV status was the primary explanatory variable. The study found no statistically significant correlation between loneliness and HIV status. However, individuals with HIV had smaller households, less physical and financial support, and were less socially integrated compared to those without HIV. In multivariable logistic regressions, loneliness was more likely among individuals who lived alone (aOR:3.38, 95% CI:1.47-7.76) and less likely among those who were married (aOR:0.34, 95% CI:0.22-0.53) and had a higher level of social integration (aOR:0.86, 95% CI: 0.79-0.92). Despite having smaller social networks and less support, older adults with HIV had similar levels of loneliness as those without HIV, which may be attributed to resiliency and access to HIV-related health services among individuals with HIV. Nonetheless, further research is necessary to better understand the mechanisms involved.
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Affiliation(s)
- Lien T Quach
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Centre for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA.
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- The Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, USA.
| | - Christine S Ritchie
- Centre for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Zahra Reynolds
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri at St. Louis, St. Louis, USA
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Yao Tong
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susanne Hoeppner
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University School of Medicine, Kampala, Uganda
| | - Brianne Olivieri-Mui
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meredith Greene
- Department of Medicine, Indiana University School of Medicine and Indiana University Center for Aging Research, Regenstreif Institute, Inc., Indianapolis, IN, USA
| | - Stephen Asiimwe
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Kabwohe Clinical Research Center, Kabwohe, Uganda
| | | | - Flavia Atwiine
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ruth Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
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Darbes LA, El Ayadi AM, Gilvydis JM, Morris J, Raphela E, Naidoo E, Grignon JS, Barnhart S, Lippman SA. Depression and HIV Care-seeking Behaviors in a Population-based Sample in North West Province, South Africa. AIDS Behav 2023; 27:3852-3862. [PMID: 37329471 PMCID: PMC10598108 DOI: 10.1007/s10461-023-04102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/19/2023]
Abstract
Depression is associated with key HIV-related prevention and treatment behaviors in sub-Saharan Africa. We aimed to identify the association of depressive symptoms with HIV testing, linkage to care, and ART adherence among a representative sample of 18-49 year-olds in a high prevalence, rural area of South Africa. Utilizing logistic regression models (N = 1044), depressive symptoms were inversely associated with reported ever HIV testing (AOR 0.92, 95% CI 0.85-0.99; p = 0.04) and ART adherence (AOR 0.82, 95% CI: 0.73-0.91; p < 0.01) among women. For men, depressive symptoms were positively associated with linkage to care (AOR: 1.21, 95% CI: 1.09-1.34; p < 0.01). Depression may adversely impact ART adherence for HIV-positive women and reduce the likelihood of HIV testing for women not aware of their HIV status which, in settings with high HIV prevalence, carries severe consequences. For HIV-positive men, findings suggest that depression may encourage help-seeking behavior, thereby impacting their health system interactions. These findings underscore the need for health-care settings to factor mental health, such as depression, into their programs to address health-related outcomes, particularly for women.
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Affiliation(s)
- Lynae A Darbes
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Alison M El Ayadi
- Department of Obstetrics and Gynecology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer M Gilvydis
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, USA
| | - Jessica Morris
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Elsie Raphela
- International Training and Education Center for Health (I-TECH), South Africa, Pretoria, Republic of South Africa
| | - Evasen Naidoo
- International Training and Education Center for Health (I-TECH), South Africa, Pretoria, Republic of South Africa
| | - Jessica S Grignon
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), South Africa, Pretoria, Republic of South Africa
| | - Scott Barnhart
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, USA
- Department of Medicine, Schools of Medicine and Public Health, University of Washington, Seattle, WA, USA
| | - Sheri A Lippman
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
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Ibigbami OI, Oginni OA, Bradley C, Lusher J, Sam-Agudu NA, Folayan MO. A cross-sectional study on resilience, anxiety, depression, and psychoactive substance use among heterosexual and sexual minority adolescents in Nigeria. BMC Public Health 2023; 23:1759. [PMID: 37689625 PMCID: PMC10493016 DOI: 10.1186/s12889-023-16660-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Mental health-related problems predispose alcohol and other psychoactive substances use as coping strategies. We assessed associations between resilience and anxiety symptoms, depressive symptoms, problematic alcohol, and multiple psychoactive substance use among sexual minority and heterosexual adolescents in Nigeria. METHODS This was a secondary analysis of a subset of data generated through an online cross-sectional study conducted between 16th and 31st of October 2020. Data extracted for adolescents in Nigeria age 13-19 years were: dependent variables (alcohol use using the CAGE test, multiple psychoactive substance use, depressive symptoms using the Patient Health Questionnaire-9, and anxiety symptoms using the Generalized Anxiety Disorder-7 measure); independent variables (resilience using the Connor-Davidson resilience scale and sexual identity), and confounding factors (age and sex). Associations between dependent and independent variables were determined using multivariable logistic regression analyses after controlling for confounders. RESULTS Of the 1419 adolescent participants, 593 (42%) were sexual minority individuals, 533 (37.6%) had high depressive symptoms, 381 (26.8%) had high anxiety symptoms, 177 (12.5%) had problematic alcohol use and 389 (27.4%) used multiple psychoactive substances. Resilience was significantly associated with lower odds of anxiety (AOR:0.96, 95% CI: 0.94-0.97, p < 0.001) and depressive (AOR:0.94, 95% CI: 0.92-0.96, p < 0.001) symptoms, problematic alcohol use (AOR:0.97, 95% CI: 0.95-0.99, p = 0.002), and multiple psychoactive substance use (AOR:0.95, 95% CI: 0.93-0.96, p < 0.001). Sexual minority adolescents had significantly higher odds of anxiety (AOR:4.14, 95% CI: 3.16-5.40, p < 0.001) and depressive symptoms (AOR:4.79; 95% CI: 3.73-6.15, p < 0.001), problematic alcohol use (AOR:2.48, 95% CI: 1.76-3.49, p < 0.001), and multiple psychoactive substance use (AOR:5.69, 95% CI: 4.34-7.47, p < 0.001). CONCLUSION Sexual minority adolescents and adolescents with low resilience have a higher need for interventions to reduce the risk of anxiety, depression, and the use of alcohol and other psychoactive substances.
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Affiliation(s)
| | | | - Cory Bradley
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | - Nadia Adjoa Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Morenike Oluwatoyin Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria.
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Stieglitz LM, Adams LB, Bärnighausen T, Berghöfer A, Kazonda P, Killewo J, Leyna GH, Lohmann J, Rohr JK, Kohler S. Depressive symptoms and their association with age, chronic conditions and health status among middle-aged and elderly people in peri-urban Tanzania. Glob Ment Health (Camb) 2023; 10:e27. [PMID: 37854410 PMCID: PMC10579685 DOI: 10.1017/gmh.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/28/2023] [Accepted: 04/25/2023] [Indexed: 10/20/2023] Open
Abstract
Background Depression is a global mental health challenge. We assessed the prevalence of depressive symptoms and their association with age, chronic conditions, and health status among middle-aged and elderly people in peri-urban Dar es Salaam, Tanzania. Methods Depressive symptoms were measured in 2,220 adults aged over 40 years from two wards of Dar es Salaam using the ten-item version of the Center of Epidemiologic Studies Depression Scale (CES-D-10) and a cut-off score of 10 or higher. The associations of depressive symptoms with age, 13 common chronic conditions, multimorbidity, self-rated health and any limitation in six activities of daily living were examined in univariable and multivariable logistic regressions. Results The estimated prevalence of depressive symptoms was 30.7% (95% CI 28.5-32.9). In univariable regressions, belonging to age groups 45-49 years (OR 1.35 [95% CI 1.04-1.75]) and over 70 years (OR 2.35 [95% CI 1.66-3.33]), chronic conditions, including ischemic heart disease (OR 3.43 [95% CI 2.64-4.46]), tuberculosis (OR 2.42 [95% CI 1.64-3.57]), signs of cognitive problems (OR 1.90 [95% CI 1.35-2.67]), stroke (OR 1.56 [95% CI 1.05-2.32]) and anemia (OR 1.32 [95% CI 1.01-1.71]) and limitations in activities of daily living (OR 1.35 [95% CI 1.07-1.70]) increased the odds of depressive symptoms. Reporting good or very good health was associated with lower odds of depressive symptoms (OR 0.48 [95% CI 0.35-0.66]). Ischemic heart disease and tuberculosis remained independent predictors of depressive symptoms in multivariable regressions. Conclusion Depressive symptoms affected almost one in three people aged over 40 years. Their prevalence differed across age groups and was moderated by chronic conditions, health status and socioeconomic factors.
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Affiliation(s)
- Laura-Marie Stieglitz
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Leslie B Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Anne Berghöfer
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Germana H Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julia Lohmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia K Rohr
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Stefan Kohler
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Mwangala PN, Nasambu C, Wagner RG, Newton CR, Abubakar A. Prevalence and factors associated with mild depressive and anxiety symptoms in older adults living with HIV from the Kenyan coast. J Int AIDS Soc 2022; 25 Suppl 4:e25977. [PMID: 36176027 PMCID: PMC9522642 DOI: 10.1002/jia2.25977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/31/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Empirical research on the burden and determinants of common mental disorders (CMDs), especially depression and anxiety, among older adults living with HIV (OALWH) in sub-Saharan Africa is inadequate. To bridge the gap in Kenya we: (1) determined the prevalence of CMDs among OALWH on routine HIV care compared to HIV-negative peers; (2) investigated HIV status as an independent predictor of CMDs in older adults; and (3) investigated CMD determinants. METHODS In a cross-sectional study conducted between 2020 and 2021, the prevalence of CMDs and associated determinants were investigated at the Kenyan coast among 440 adults aged ≥50 years (257 OALWH). The Patient Health Questionnaire and Generalized Anxiety Disorder scale were administered alongside measures capturing biopsychosocial information. Logistic regression was used to examine the correlates of CMDs. RESULTS No significant differences were found in the prevalence of mild depressive symptoms, 23.8% versus 18.2% (p = 0.16) and mild anxiety symptoms, 11.7% versus 7.2% (p = 0.12) among OALWH compared to HIV-negative peers, respectively. HIV status was not independently predictive of CMDs. Among OALWH, higher perceived HIV-related stigma, ageism, increasing household HIV burden, loneliness, increasing functional disability, sleeping difficulties, chronic fatigue and advanced age (>70 years) were associated with elevated CMDs. Among HIV-negative older adults, loneliness, increased medication burden and sleeping difficulties were associated with elevated depressive symptoms. Easier access to HIV care was the only factor associated with lower CMDs among OALWH. CONCLUSIONS On the Kenyan coast, the burden of moderate and severe CMDs among older adults is low; however, both OALWH and their HIV-negative peers have a similar relatively high burden of mild depressive and anxiety symptoms. Our results also suggest that determinants of CMDs among OALWH in this setting are predominantly psychosocial factors. These results highlight the need for psychosocial interventions (at the family, community and clinical levels) to mitigate the risks of mild CMDs as they are known to be potentially debilitating.
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Affiliation(s)
- Patrick N. Mwangala
- Centre for Geographic Medicine Research CoastKenya Medical Research Institute (KEMRI)KilifiKenya,School of Public HealthUniversity of the WitwatersrandParktownSouth Africa,Institute for Human DevelopmentAga Khan UniversityNairobiKenya
| | - Carophine Nasambu
- Centre for Geographic Medicine Research CoastKenya Medical Research Institute (KEMRI)KilifiKenya
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)Faculty of Health Sciences, University of the WitwatersrandJohannesburgSouth Africa
| | - Charles R. Newton
- Centre for Geographic Medicine Research CoastKenya Medical Research Institute (KEMRI)KilifiKenya,Institute for Human DevelopmentAga Khan UniversityNairobiKenya,Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK,Department of Public HealthPwani UniversityKilifiKenya
| | - Amina Abubakar
- Centre for Geographic Medicine Research CoastKenya Medical Research Institute (KEMRI)KilifiKenya,Institute for Human DevelopmentAga Khan UniversityNairobiKenya,Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK,Department of Public HealthPwani UniversityKilifiKenya
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Perianayagam A, Prina M, Selvamani Y, Gudekar D, Salvi S, Varghese M, Dandona R. Sub-national patterns and correlates of depression among adults aged 45 years and older: findings from wave 1 of the Longitudinal Ageing Study in India. Lancet Psychiatry 2022; 9:645-659. [PMID: 35843255 PMCID: PMC9375859 DOI: 10.1016/s2215-0366(22)00186-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 04/22/2022] [Accepted: 05/04/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Depression is a major public health challenge linked with several poor health outcomes and disabilities among adults aged 45 years and older in India. We aimed to describe the prevalence of depression and its association with a variety of sociodemographic correlates and co-existing health conditions for this age group in India and its states. METHODS In this prospective cohort study, data from wave 1 (baseline) of the Longitudinal Ageing Study in India were used to estimate the national and subnational state level age-standardised prevalence of depression-major depressive episodes-using the internationally validated Composite International Diagnostic Interview-Short Form (CIDI-SF) scale. Hierarchical mixed effect multivariate logistic regression models were used to study the sociodemographic correlates and co-existing health conditions of major depressive episodes among the nationally representative sample of 72 250 adults aged 45 years and older from 35 states or union territories (except the state of Sikkim). Associations between depression and self-rated health, co-morbid conditions, functional health, and life satisfaction measures were also examined. FINDINGS A total of 40 335 (58·3%) females and 29 407 (41·7%) males aged 45 to 116 years (median age 58 years) participated. The overall age-standardised prevalence of depression based on CIDI-SF scale was 5·7% (95% CI 5·5-5·8) compared with 0·5% (0·5-0·6) self-reported prevalence of depression among adults aged 45 years and older in India. Wide sub-national variations were seen in depression prevalence, ranging from 0·8% (95% CI 0·3-1·3) in Mizoram state to 12·9% (11·6-14·2) in Madhya Pradesh. Prevalence was higher in females (6·3% [95% CI 6·1-6·6] vs 4·3% [4·1-4·6]) for India, and this higher prevalence was more pronounced in some of the northern states. The risk of depression was higher in those residing in rural areas, widowed, with no or low education, and in the poorest quintile. Depression showed a strong positive association with poor self-rated health (OR 2·39 [95% CI 2·21-2·59]; p<0·0001), with one or more limitations in the activities of daily living (ADL; OR 1·60 [1·46-1·75]; p<0·0001), instrumental ADL limitations (OR 1·51 [1·40-1·64]; p<0·0001), and low cognitive judgment of life satisfaction (OR 1·94 [95% CI 1·78-2·10]; p<0·0001). INTERPRETATION Despite the substantial burden, depression remains undiagnosed and strongly linked with poor health and wellbeing outcomes in adults aged 45 years and older in India. The ageing population of India and the subnational variations amplify the implications of this new evidence to address the substantial gaps in prevention and treatment of depression. FUNDING LASI was funded by the Ministry of Health and Family Welfare, Government of India, the National Institute of Ageing, USA and the United Nations Population Fund, India.
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Affiliation(s)
- Arokiasamy Perianayagam
- International Institute for Population Sciences, Mumbai, India; National Council of Applied Economic Research, Delhi, India
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Y Selvamani
- International Institute for Population Sciences, Mumbai, India
| | - Dipika Gudekar
- International Institute for Population Sciences, Mumbai, India
| | - Supriya Salvi
- International Institute for Population Sciences, Mumbai, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health Sciences and Neurosciences, Bengaluru, India
| | - Rakhi Dandona
- Public Health Foundation of India, Gurugram, India; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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Sobregrau P, Peri JM, Sánchez del Valle R, Molinuevo JL, Barra B, Pintor L. Psychiatric and Psychosocial Characteristics of a Cohort of Spanish Individuals Attending Genetic Counseling Due to Risk for Genetically Conditioned Dementia. J Alzheimers Dis Rep 2022; 6:461-478. [PMID: 36186729 PMCID: PMC9484134 DOI: 10.3233/adr-210067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Predictive genetic tests are presently effective over several medical conditions, increasing the demand among patients and healthy individuals. Considering the psychological burden suspected familial dementia may carry on individuals, assessing personality, coping strategies, and mental health could aid clinicians in findings the appropriate time for delivering genetic test results and predict compliance regarding genetic counseling and expectations towards the genetic condition depending on the outcome. Objective: To describe the psychiatric, psychological, and coping characteristics of a sample of Spanish individuals at risk of familial dementia before genetic test results were given. Methods: We included 54 first degree relatives of patients diagnosed with Alzheimer’s disease, lobar frontotemporal degeneration, or prion diseases. The NEO-FFI-R, COPE, and HADS tests evaluated personality, coping strategies, and psychological distress, respectively. Results: Anxiety and depression were below the cut-off point for mild severity. Conscientiousness and Agreeableness were the most preponderant personality factors, while Neuroticism was the least. Positive reinterpretation and Acceptance were the most frequent coping strategies, and Denial and Alcohol and drug use were the least used. Ongoing medical pathologies increased depression, while psychiatric disorders worsened psychological distress. Conclusion: Contrary to our expectations, PICOGEN candidates showed psychological distress and personality traits within normative ranges, and the use of problem-focused coping strategies prevailed over avoidance coping strategies. Nevertheless, clinicians should pay particular attention to individuals attending genetic counseling who are women, aged, and present an ongoing psychiatric disorder and psychiatric history at inclusion to ensure their mental health and adherence throughout the process.
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Affiliation(s)
- Pau Sobregrau
- Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Psychology Faculty, University of Barcelona (UB), Barcelona, Spain
| | - Josep M. Peri
- Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Raquel Sánchez del Valle
- Neurology Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Bernardo Barra
- Clínica Universidad de Los Andes, Servicio de Salud Mental, Santiago, Chile
- Psychiatric Department, School of Medicine, Andrés Bello University, Santiago, Chile
| | - Luís Pintor
- Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
- Psychology Faculty, University of Barcelona (UB), Barcelona, Spain
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
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10
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Tiwari S, Qi L, Wong J, Han Z. Association of peripheral manifestation of brain-derived neurotrophic factor with depression: A meta-analysis. Brain Behav 2022; 12:e32581. [PMID: 35510613 PMCID: PMC9226806 DOI: 10.1002/brb3.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 03/03/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The relationship between brain-derived neurotrophic factor (BDNF) and depression is a hot topic in research as several results of preclinical and clinical studies have shown controversial results. Our meta-analysis aims to evaluate and update the current status of peripheral BDNF with depression. METHODS We performed a meta-analysis by comprehensively searching PubMed and Web of Science for English-language literature from inception to 1st of June 2020. The search terms included brain-derived neurotrophic factor or BDNF in combination with depression, without year restriction. Using STATA software, data were pooled using a random-effects model. RESULTS In our literature search, 24 studies involving 1130 depressed patients and 1378 healthy individuals met our inclusion criteria. The results of our meta-analysis showed that the peripheral levels of BDNF levels significantly decreased in depression than nondepressed healthy controls (SMD = -0.89, 95% CI = -1.41, -0.38, p < .0001); however, the significant heterogeneity among studies (Q = 740.91, I2 = 96.8; p < .001) was discovered. Trim-and-fill estimations for the adjustment of publication bias indicated that publication bias had no impact on our results. Our sub-group analysis showed that a history of depression and alcohol consumption had an effect on the level of BDNF. In addition, age and gender did not affect the heterogeneity of BDNF in the meta-analysis. CONCLUSIONS Although decreased peripheral expression of BDNF certainly presents a risk of depression, we cannot find a definite relationship between the peripheral level of BDNF with depression to use BDNF as a reliable biomarker to assess the depression in clinical practice. We propose that future research should consider all the factors affecting BDNF and assess the level of proBDNF and mBDNF separately while evaluating the patients with depression objectively.
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Affiliation(s)
- Sagun Tiwari
- Department of Neurology and Rehabilitation, Seventh People's Hospital of Shanghai University of TCM, Shanghai, P. R. China.,International Education College, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Lili Qi
- Department of Emergency Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of TCM, Shanghai, P. R. China
| | - John Wong
- School of Nursing and Department of Occupational Therapy, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Zhenxiang Han
- Department of Neurology and Rehabilitation, Seventh People's Hospital of Shanghai University of TCM, Shanghai, P. R. China
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11
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van Empel E, de Vlieg RA, Montana L, Gómez-Olivé FX, Kahn K, Tollman S, Berkman L, Bärnighausen TW, Manne-Goehler J. Older Adults Vastly Overestimate Both HIV Acquisition Risk and HIV Prevalence in Rural South Africa. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3257-3276. [PMID: 34599468 PMCID: PMC8563552 DOI: 10.1007/s10508-021-01982-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 06/13/2023]
Abstract
Perceptions of HIV acquisition risk and prevalence shape sexual behavior in sub-Saharan Africa (SSA). We used data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa baseline survey. Data were collected through home-based interviews of 5059 people ≥ 40 years old. We elicited information on perceived risk of HIV acquisition and HIV prevalence among adults ≥ 15 and ≥ 50 years old. We first describe these perceptions in key subgroups and then compared them to actual estimates for this cohort. We then evaluated the relationship between sociodemographic characteristics and accurate perceptions of prevalence in regression models. Finally, we explored differences in behavioral characteristics among those who overestimated risk compared to those who underestimated or accurately estimated risk. Compared to the actual HIV acquisition risk of < 1%, respondents vastly overestimated this risk: 35% (95% CI: 32-37) and 34% (95% CI: 32-36) for men and women, respectively. Respondents overestimated HIV prevalence at 53% (95% CI: 52-53) for those ≥ 15 years old and 48% (95% CI: 48-49) for those ≥ 50 years old. True values were less than half of these estimates. There were few significant associations between demographic characteristics and accuracy. Finally, high overestimators of HIV prevalence tested themselves less for HIV compared to mild overestimators and accurate reporters. More than 30 years into the HIV epidemic, older people in a community with hyperendemic HIV in SSA vastly overestimate both HIV acquisition risk and prevalence. These misperceptions may lead to fatalism and reduced motivation for prevention efforts, possibly explaining the continued high HIV incidence in this community.
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Affiliation(s)
- Eva van Empel
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA.
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Rebecca A de Vlieg
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Livia Montana
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA
| | - F Xavier Gómez-Olivé
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Kathleen Kahn
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Stephen Tollman
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Till W Bärnighausen
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute, Mtubatuba, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jennifer Manne-Goehler
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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12
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Mwangala PN, Mabrouk A, Wagner R, Newton CRJC, Abubakar AA. Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review. BMJ Open 2021; 11:e052810. [PMID: 34551953 PMCID: PMC8461287 DOI: 10.1136/bmjopen-2021-052810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/06/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE In this systematic review, we aimed to summarise the empirical evidence on common mental disorders (CMDs), cognitive impairment, frailty and health-related quality of life (HRQoL) among people living with HIV aged ≥50 years (PLWH50 +) residing in sub-Saharan Africa (SSA). Specifically, we document the prevalence and correlates of these outcomes. DESIGN, DATA SOURCES AND ELIGIBILITY CRITERIA The following online databases were systematically searched: PubMed, CINAHL, PsycINFO, Embase and Scopus up to January 2021. English-language publications on depression, anxiety, cognitive function, frailty and quality of life among PLWH50+ residing in SSA were included. DATA EXTRACTION AND SYNTHESIS We extracted information, including study characteristics and main findings. These were tabulated, and a narrative synthesis approach was adopted, given the substantial heterogeneity among included studies. RESULTS A total of 50 studies from fifteen SSA countries met the inclusion criteria. About two-thirds of these studies emanated from Ethiopia, Uganda and South Africa. Studies regarding depression predominated (n=26), followed by cognitive impairment (n=13). Overall, PLWH50+ exhibited varying prevalence of depression (6%-59%), cognitive impairments (4%-61%) and frailty (3%-15%). The correlates of CMDs, cognitive impairment, frailty and HRQoL were rarely investigated, but those reported were sociodemographic variables, many of which were inconsistent. CONCLUSIONS This review documented an increasing number of published studies on HIV and ageing from SSA. However, the current evidence on the mental and well-being outcomes in PLWH50+ is inadequate to characterise the public health dimension of these impairments in SSA, because of heterogeneous findings, few well-designed studies and substantial methodological limitations in many of the available studies. Future work should have sufficiently large samples of PLWH50+, engage appropriate comparison groups, harmonise the measurement of these outcomes using a standardised methodology to generate more robust prevalence estimates and confirm predictors. PROSPERO REGISTRATION NUMBER CRD42020145791.
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Affiliation(s)
- Patrick Nzivo Mwangala
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Adam Mabrouk
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ryan Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parkton, Gauteng, South Africa
| | - Charles R J C Newton
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina A Abubakar
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
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13
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Brinkmann B, Payne CF, Kohler I, Harling G, Davies J, Witham M, Siedner MJ, Sie A, Bountogo M, Ouermi L, Coulibaly B, Bärnighausen T. Depressive symptoms and cardiovascular disease: a population-based study of older adults in rural Burkina Faso. BMJ Open 2020; 10:e038199. [PMID: 33371016 PMCID: PMC7757460 DOI: 10.1136/bmjopen-2020-038199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To contribute to the current understanding of depressive disorders in sub-Saharan African (SSA) countries by examining the association of depressive symptoms with cardiovascular and cardiometabolic conditions in a population-based study of middle-aged and older adults in rural Burkina Faso. SETTING This study was conducted in the Nouna Health and Demographic Surveillance System in north-western Burkina Faso, in a mixed rural and small-town environment. The data were obtained between May and July 2018. PARTICIPANTS Consenting adults over 40 years of age (n=3026). PRIMARY AND SECONDARY OUTCOME MEASURES Depressive symptoms were assessed using the Patient Health Questionnaire depression module (PHQ-9). Chronic cardiometabolic conditions were assessed via a lipid panel and glycated haemoglobin measures from serum, alongside anthropometry and blood pressure measurements and a self-reported questionnaire. Multivariable linear regression was used to test the relationship between depressive symptoms and cardiovascular/cardiometabolic conditions after controlling for sociodemographic factors. RESULTS Depressive symptoms were not associated with the metabolic syndrome (standardised beta coefficient=0.00 (95% CI -0.04 to 0.03)), hypertension (beta=0.01 (95% CI -0.02 to 0.05)), diabetes mellitus (beta=0.00 (95% CI -0.04 to 0.04)) and past diagnosis of elevated blood pressure or blood sugar. Prior stroke diagnosis (beta=0.04 (95% CI 0.01 to 0.07)) or heart disease (beta=0.08 (95% CI 0.05 to 0.11)) was positively associated with the standardised PHQ-9 score as were self-reported stroke symptoms. CONCLUSION Objectively measured cardiometabolic conditions had no significant association with depressive symptoms in an older, poor, rural SSA population, in contrast to observations in high income countries. However, consequences of cardiovascular disease such as stroke and heart attack were associated with depressive symptoms in older adults in Burkina Faso.
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Affiliation(s)
- Ben Brinkmann
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Collin F Payne
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Iliana Kohler
- Population Studies Center (PSC) and Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guy Harling
- Institute for Global Health, University College London, London, UK
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Miles Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mark J Siedner
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Sie
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Mamadou Bountogo
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Lucienne Ouermi
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Boubacar Coulibaly
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
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14
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Endomba FT, Mazou TN, Bigna JJ. Epidemiology of depressive disorders in people living with hypertension in Africa: a systematic review and meta-analysis. BMJ Open 2020; 10:e037975. [PMID: 33303433 PMCID: PMC7733170 DOI: 10.1136/bmjopen-2020-037975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Better knowledge of epidemiology of depressive disorders in people living with hypertension can help to implement pertinent strategies to address its burden. The objective was to estimate the prevalence of depressive disorders and symptoms in people living with hypertension in Africa. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE, African Index Medicus, African Journals OnLine were searched up to 31 January 2020, regardless of the language of publication. ELIGIBILITY CRITERIA We included studies conducted among adult patients with hypertension (≥18 years) living in Africa and reporting the prevalence of depressive disorders and symptoms. DATA EXTRACTION AND SYNTHESIS Two independent investigators selected studies, extracted data and assessed the methodological quality of included studies by using the tools developed by Joanna Briggs Institute. Multivariate random-effects meta-analysis served to pool data by considering the variability between diagnostic tools used to identify patients with depressive disorders or symptoms. RESULTS We included 11 studies with 5299 adults with hypertension. Data were collected between 2002 and 2017, from South Africa, Nigeria, Ghana, Ethiopia and Burkina Faso. The mean age varied between 50.3 years and 59.6 years. The proportion of men ranged from 28% to 54%. The adjusted prevalence of depressive disorders taking into account the variance between diagnostic tools was 17.9% (95% CI 13.0% to 23.4%). The prevalence of depressive symptoms and major depressive symptoms was 33.3% (95% CI 9.9% to 61.6%) and 7.8% (95% CI 3.0% to 14.5%), respectively. There was heterogeneity attributable to the diagnostic tools for depressive disorders and symptoms. There was no publication bias. CONCLUSION Notwithstanding the representativeness lack of some (sub) regions of Africa, weakening the generalisability of findings to the entire region; depressive disorders and symptoms are prevalent in people living with hypertension in Africa, indicating that strategies from clinicians, researchers and public health makers are needed to reduce its burden in the region.
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Affiliation(s)
- Francky Teddy Endomba
- Health Economics and Policy Research and Evaluation for Development Results Group, Yaounde, Cameroon
- Psychiatry Internship Program, Université de Bourgogne, Dijon, Bourgogne, France
| | - Temgoua Ngou Mazou
- Health Economics and Policy Research and Evaluation for Development Results Group, Yaounde, Cameroon
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur du Cameroun, Yaounde, Cameroon
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15
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Adams LB, Farrell M, Mall S, Mahlalela N, Berkman L. Dimensionality and differential item endorsement of depressive symptoms among aging Black populations in South Africa: Findings from the HAALSI study. J Affect Disord 2020; 277:850-856. [PMID: 33065826 PMCID: PMC7575820 DOI: 10.1016/j.jad.2020.08.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/10/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Center for Epidemiologic Studies-Depression (CES-D) scale is a widely used measure of depressive symptoms, but its construct validity has not been adequately assessed in sub-Saharan Africa. This study validates the CES-D among an aging Shangaan-speaking and predominantly Black African sample in rural South Africa, with a special emphasis on gender differences. METHODS An 8-item CES-D scale was administered in Shangaan to 5059 respondents, aged 40+ years, residing in Agincourt, South Africa. We used Cronbach's alpha and exploratory and confirmatory factor analysis to examine and confirm dimensionality of the CES-D scale. Differential endorsement of CES-D items by gender were assessed using the Mantel-Haenszel (MH) odds ratio test. RESULTS Reliability of the CES-D scale differed by gender with women reporting higher internal consistency on items than men. A two-factor solution was retained and confirmed representing two latent factors: (1) Negative Affect (six items) and (2) Diminished Positive Affect (two items). MH results showed that men exhibited significantly higher odds of putting an effort in everything that they did (OR: 1.33, 95% CI: 1.15-1.54) and lower odds of feeling depressed (OR: 0.71, 95% CI: 0.56-0.89) and having restless sleep (OR: 0.67, 95% CI:0.58-0.77) than women. LIMITATIONS Analyses were limited to a dichotomous, short form of the CES-D, a self-reported population-based measure. CONCLUSION Aging Black Africans differ in endorsing affective and somatic items on the CES-D scale by gender, which may lead to skewed population-level estimates of depression in key subpopulations. These findings highlight the importance of continued research disentangling cross-cultural and gendered nuances of depression measurements.
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Affiliation(s)
- Leslie B. Adams
- Harvard Center for Population and Development Studies,
Harvard University, Cambridge, MA, USA,Department of Mental Health, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
| | - Meagan Farrell
- Department of Mental Health, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
| | - Sumaya Mall
- Division of Epidemiology and Biostatistics, School of
Public Health, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa
| | - Nomsa Mahlalela
- MRC/Wits Rural Public Health and Health Transitions
Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Berkman
- Harvard Center for Population and Development Studies,
Harvard University, Cambridge, MA, USA
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16
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Jennings EA, Ralston M, Schatz E. Support in times of need: How depressive symptoms can impact receipt of social support among aging adults in rural South Africa. SSM Popul Health 2020; 12:100666. [PMID: 33072842 PMCID: PMC7549146 DOI: 10.1016/j.ssmph.2020.100666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/08/2020] [Accepted: 09/07/2020] [Indexed: 01/28/2023] Open
Abstract
The relationship between mental health and receipt of social support is not well understood in low- and middle-income countries. In this paper, we focus on a cohort of older adults (40-plus) in rural South Africa to unpack associations between mental health and receipt of social support, and the extent to which marital status modifies these associations. We use baseline data from a population-based study, Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), conducted between 2014 and 2015. Our results suggest that men and women who report depressive symptoms are less likely to receive social support: women are less likely to receive emotional and financial support, and men are less likely to receive physical and financial support. Both men and women who are married or partnered are more likely to receive social support than their non-married counterparts. The association between depressive symptomology and receipt of social support differs for women who are separated/divorced and for men who are widowed. Specifically, the association between having depressive symptoms and receiving physical or financial support is more positive for separated/divorced women than their married/cohabiting counterparts; for men, the association between having depressive symptoms and receiving physical support is more positive for widowed men than their married/cohabiting counterparts. Our findings speak to the complicated associations between social support, marriage and mental health in later life and the different experiences that men and women may have. We estimate links between mental health and receipt of social support among a cohort of aging adults in rural South Africa. Having depressive symptoms is negatively associated with odds of receiving some types of social support for men and women. Married men and women have greater odds of receiving all types of social support relative to non-married counterparts. Depressive symptoms are more positively associated with receipt of physical support for widowed vs. married men. Depressive symptoms more positively linked with receipt of physical or financial support for divorced vs. married women.
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Affiliation(s)
- Elyse A Jennings
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Enid Schatz
- Department of Public Health and Women's & Gender Studies, University of Missouri, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersand, Johannesburg, South Africa
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17
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Abstract
As the world undergoes rapid ageing, informal support from friends and relatives is becoming especially important among older adults in middle and low income countries, where formalized social protections may be limited. We use new data from a cohort of adults ages 40 and older in rural South Africa to explore how receipt of emotional support differs by gender and marital status. Our findings suggest that women are more likely to get emotional support than men and have more sources of support. Moreover, women are more likely to get emotional support from relatives, whereas men are more likely to get support from friends. In regard to marital status, married people are more likely to get emotional support and have more sources of support than people who are not married. However, separated/divorced and widowed people are more likely to get emotional support from relatives and have more sources of non-spousal support than married people. These findings point toward gaps in informal systems of support, and the particular importance of considering men and unmarried (especially never married) people when designing policies to offer social protections to older populations.
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18
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Payne CF, Mall S, Kobayashi L, Kahn K, Berkman L. Life-Course Trauma and Later Life Mental, Physical, and Cognitive Health in a Postapartheid South African Population: Findings From the HAALSI study. J Aging Health 2020; 32:1244-1257. [PMID: 32207348 DOI: 10.1177/0898264320913450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the relationships between exposure to life-course traumatic events (TEs) and later life mental, physical, and cognitive health outcomes in the older population of a rural South African community. Method: Data were from baseline interviews with 2,473 adults aged ≥40 years in the population-representative Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) study, conducted in 2015. We assessed exposure to 16 TEs, and used logistic regression models to estimate associations with depression, post-traumatic stress disorder (PTSD), activities of daily living disability, and cognitive impairment. Results: Participants reported an average of 5 (SD = 2.4) TEs over their lifetimes. Exposure was ubiquitous across sociodemographic and socioeconomic groups. Trauma exposure was associated with higher odds of depression, PTSD, and disability, but not with cognitive health. Discussion: Results suggest that TEs experienced in earlier life continue to reverberate today in terms of mental health and physical disability outcomes in an older population in rural South Africa.
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Affiliation(s)
| | - Sumaya Mall
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Kathy Kahn
- University of the Witwatersrand, Johannesburg, South Africa.,Umeå University, Sweden
| | - Lisa Berkman
- University of the Witwatersrand, Johannesburg, South Africa.,Harvard T.H. Chan School of Public Health, Cambridge, USA
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